CHEYENNE, Wyo. (Legal Newsline) - The Wyoming Supreme Court has overturned the decision of a lower court that denied medical benefits to a man whose spinal cord simulator caused a hernia.
In its opinion filed Sept. 22, the state's high court held that the man's hernia occurred "in the course of the employment" and reversed a Laramie County district court's decision that reversed an Office of Administrative Hearings order.
James L. Ball suffered the hernia when a spinal cord stimulator, implanted to treat chronic back pain from an earlier compensable work-related injury, malfunctioned and shocked him. The malfunctioning caused him to stand rapidly and then fall, according to Court documents.
In June 1993, while at work, Ball slipped on a drain cover as he was walking into a walk-in refrigerator to get some milk and injured his shoulder, neck, back and right leg.
Following the accident, Ball was awarded permanent total disability benefits and has received ongoing benefits for treatment of chronic pain, including narcotic pain medications and implantation of a spinal cord stimulator.
Ball originally had the stimulator implanted in 2000. By May 2006, the original stimulator was no longer operable and a new one was implanted.
But with the new stimulator came painful side effects that he described as "good jolts" or "a shocking sensation." The effects would occur without warning while he was laying down or moved in a certain way.
In mid-July 2007, Ball was at home lying in bed when he experienced a sensation that caused him to try to stand up "real fast." As he stood, he fell back down and then experienced a pain in his groin that he had never before. Ball tried to call his physician, fearing he had broken a wire on the new stimulator.
A few days after falling, Ball saw a board certified psychologist and neurologist who had treated the man for some time. She wrote of his visit, "At our appointment, it was clear that Mr. Ball was in more pain."
Days later, Ball was examined by Dr. James Shaw. At the time, Shaw noted, "He is complaining of classic hernia complaints after this fall from his electrical feeling in his legs. I would consider this a work-related problem based off the origin of the fall."
Following an abdominal CT scan, which revealed an inguinal hernia, Ball underwent surgery on Aug. 16, 2007.
Ball saw Young again on Dec. 6, 2007, after undergoing hernia surgery. Young concluded, "(I)t would appear that the hernia developed as a consequence of the neurological sequelae of Mr. Ball's work-related injury."
Soon after, the Division issued a final determination denying payment for treatment of Ball's hernia on the basis that it was not related to the original 1993 injury to his back.
Ball objected to the Division's determination, and the matter was referred for a contested case hearing. During the hearing, Ball contended he was entitled to benefits to cover the costs related to his hernia because the development of his hernia was causally related to his original work-related injury.
Specifically, Ball claimed his fall was caused by a malfunction in his electrical stimulator, which was prescribed and implanted to treat his chronic low back pain.
The hearing examiner found that Ball had proved all of the statutorily required elements and that the man's hernia was therefore a compensable injury.
The Division appealed the examiner's order to the district court.
In July 2009, the court entered its order, deferring to the examiner's findings of fact. It found those were supported by substantial evidence. However, it concluded, under the hernia statute, that a hernia is a compensable injury only when it is the original injury.
Supreme Court Justice Michael Golden, who authored the opinion, said at issue was whether the hernia occurred "in the course of the employment" as that term appears in Wyoming Code.
Ball contends that "in the course of employment" means a hernia is compensable if it is found to be causally related to the employee's original work injury, assuming all of the other elements of the statute are met.
The Division, on the other hand, contends that the phrase means the hernia must have been the original injury and must have occurred in the workplace to be compensable.
Golden wrote, "We find Ball's position to be more persuasive as it is in keeping with the plain language and context of the hernia statute, as well as the legislative intent."
The Court said the hearing examiner's finding that the authorized medical treatment for Ball's original work injury caused his subsequent hernia is uncontested.
"(A)nd the district court erred in holding that benefits were barred on the ground that the second compensable injury rule could not be applied," the Court wrote.
The Court, in its decision, reversed and remanded to the district court "for a remand to the Office of Administrative Hearings for reinstatement of the hearing examiner's original order awarding benefits."
From Legal Newsline: Reach Jessica Karmasek by e-mail at email@example.com.